The ideas for savings to the health care system are endless! We know already, of course, about the great new idea of not looking so closely at those breasts. What we don't know won't cause us anxiety, and if cancer should come, the later we discover it the better, because there is nothing like death to stop us from running to the doctor for every little thing.

Young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

And talk about expensive! Premature births and Caesarean sections? Wouldn't it be so much nicer for everyone if women would man up and give the old vagina a go? And if the baby dies? Think of how many trips to the pediatrician will be avoided. Why spend so much on preemies anyway? Surely, the new guidelines on extra-tiny humans will yield nice savings.

There are 11,270 new cases of cervical cancer and 4,070 deaths per year in the United States. One to 2 cases occur per 1,000,000 girls ages 15 to 19 — a low incidence that convinces many doctors that it is safe to wait until 21 to screen.

Oh, now, don't go all squishy on that one-in-a-million 15 year old girl. We've got to get costs under control. And if, by some quirk of fate, she happens to be your little girl, the experts are here to tell you that you will feel quite a bit better — surprisingly so — when you look at an old photograph of your lost child.

Come on, be honest. Don't you want the federal government to have a complete overview of health care? The potential rationality is stunning. And one thing in this emerging rationality is clear: Although women tend to love the notion of government control more than men do, it is women who will be told they'll have to cut back. On treatments. And years. You know we've been taking more than our share.

168 comments:

Ann, that pesky rising life expectancy has thrown off the accuarial tables for social security and medicare. Rather than raising the eligibility ages for both, it is easier just to bring the life expectancy back down.

I mean, come on, who needs a bunch of old people around (especially old baby boomers)? Win Win!

Although women tend to love the notion of government control more than men do, it is women who will be told they'll have to cut back. On treatments. And years. You know we've been taking more than our share.

It's true!And though we haven't been taking more than our share, obviously, we are expensive. Yet women's groups, rather than admitting that, come up with a lame "Being a woman is not a preexisting condition" movement.

So women want government health care because it will save money, don't want any of the tests women will get decreased, don't want to pay more than men, and will talk about how personal it all is -my right to abortion! my breasts!-- so no man dares participate in the conversation.

More proof that the epic dystopias predicted by earnest movie producers and sci-fi authors as coming from the Nazi right, whatever htat is, is, as predicted and predictable, coming to us from the left. As it would.

These ideas don't exactly spring from the minds of Milton Friedman, Ayn Rand and Ronald Reagan...but the lefties persist, and I have a feeling they know the results of authoritarianism, but they like it, with that little gleeming twinkle of being Naughty.

rising life expectancy has thrown off the accuarial tables for social security and medicare. Rather than raising the eligibility ages for both, it is easier just to bring the life expectancy back down.

That is an excellent point. The Dems should redo their cost savings calculations to include decreased SS payouts. We'll save trillions!

Nobody pays much attention to the real reason medical care has become more expensive-- there is more of it and it is much better than it used to be.

An analogy is the cost of automobiles, which has actually increased as a percentage of income while most technology has decreased. The reason is that cars do more and do it better and more reliably than they did when they were cheaper. In short, consumers judge that they are worth it.

I myself suffered from two distinct medical conditions that would have had much worse outcomes just twenty-five years ago. The medical bills were unbelievable, private insurance paid for it all, and I am fine.

The point is that the present system incentivizes research into therapies that consumers might want to pay for. When the government decides what is "worth it" rather than consumers, all incentive is gone. Medical science will progress glacially, if at all, and we will all suffer for it.

The recommendations are from a peer group of OB/GYNs, not a government agency. They are making these recommendations to reduce the complications of unnecessary procedures. Weighing risks against each other is always a tough business. But I'd rather have doctors and scientists examining those risks (as they are here), than government agencies.

Of course, being a male of the species, I can't get hysterical about it. But, yes, I think you should be somewhat more rational here than you're being.

When the state is paying for your body, the state owns your ass. From simple things like mandating bike helmets and banning trans fats, to rationing and delaying of procedures, refusing to cover certain drugs, and pushing euthanasia, the state will HAVE to find cost saving measures.

Women and babies consume a hugely disproportionate amount of health care - but that is just inevitable given the systems and complexities involved, but assuming that we want to continue the species, that's just the deal.

The left's love affair with cost cutting and junk science are going to make a lethal combination. Once the government owns healthcare, any quack remedy that cuts costs and fits the PC world view (i.e. wasn't invented by a drug company and doesn't require new techology)will be adopted. Scary.

That notion of women being as equally valuable as a man is so American and so Christian. Don't you females know that the rest of the world doesn't see women that way at all and never has. How arrogant of you to expect these strange Traditional views of American Christians to rule when money is needed to fund Czars and Community Activists who are Real Male Leadership. Just ask Mohammed how valuable you really are to his followers; and Obama is committed to meeting his followers at least half way so that he can bring us Peace. Don't you want peace? Just lie down and shut up until Barack and Ophra make you see how happy this change can make you feel as you are sacrificed for the Anointed Chosen Male Leader.

I do not want the government to determine my medical treatments. I am emphatically opposed to any health care bill out there.

However. Just because we have been told for so long that annual paps and mamograms were a good idea, doesn't mean that new research has to agree with that. When insurance companies are told that full coverage of preventive medicine is a must-have, the cost of those preventive measures is bound to rise. Doctors don't have to think about whether the test is really necessary because the patient won't have to pay for it.

If this research is on the level (and I'm not the one to analyze methodologies), why isn't that a good thing? Nothing I have read sounds like a deliberate attempt to harm patients. I'd be happy to have a reason not to have an annual pap and mamo, myself. And for those who insist that annuals are saving all our lives, why not do the tests every six months? Maybe that would save even more lives.

For most of us, we do what is recommended by our doctors and we do what our insurance company will pay for. Now, with the new recommendations, perhaps we'll have to think about it a bit more...especially if some of us will end up needing to pay for the tests every other year. How is that a bad thing?

holdfast:Women and babies consume a hugely disproportionate amount of health care - but that is just inevitable given the systems and complexities involved, but assuming that we want to continue the species, that's just the deal.

No, that's not the deal.

Feminists have long used breast cancer as a political ploy. It works. Anybody who questions the next dollar of spending is depicted as wanting women to die, and who wants that?

The gay lobby has used HIV/AIDS the same way, and to the same effect.

But it's not just feminists and gays. Remember, someone else benefits from all this: politicians always benefit from controlling the flow of taxpayer dollars.

Didn't you post about some British reality star who died at 25 of cervical cancer? They screen only every 5 years in UK.

Also, while they love to say we have higher infant mortality rates, I recently learned that they (in the UK and Europe) catgetorize babies born premature that die as miscarriages and we count them as live birth. Also, babies born before 22 weeks will not receive medical treatment, so when they die, it is a miscarriage.

Keep in mind that the old recommendations for annual screening were made prior to the availability of the vaccine for the strains of HPV (human papilloma virus) that cause 70% of cervical cancers. With vaccination of teens and the potential to reduce cervical cancer by 70% in this age range, it seems reasonable that it's not necessary to screen as frequently.

Besides, what 15-year olds are getting routine pelvic exams? I've only heard it recommended for early teens if they are sexually active, in which case, HPV is the biggest risk factor, not other abnormalities.

If the standard being advocated is catching all abnormalities that MIGHT cause future problems, perhaps we should just require all insurers to cover annual full body scans from birth onward. By the logic applied here (catch abnormalities at any price, regardless of rarity), that would be the only humane way to go, and damn the expense.

Serious rationing requires a cost benefit equation. The point at which a dollar of care doesn't return a day of happyness and productiveness is the day we abandon you. Traditional Medical attitudes were that whatever saved lives was to be done at any cost. But communism is broke since no one really works and no one is really paid. Obama is just letting us find out about this truth next year. He will dither for as long as it takes. Then we will wake up screaming for a place in line to get whatever bread crumbs our new socialist god fathers will throw us, just like they do in Cuba.

This practice of the medical profession to generalize and play the odds explains why a family friend died from testicular cancer at age 42. A family practitioner, he evidently knew he was far out of the age range for testicular cancer, and ignored it till it was too late.

I've been reading this blog for years, but I think this is my first comment.

I'm shocked to find althouse so anti-science. The mammography recommendations are based on 30-odd years of data and studies involving, literally, hundreds of thousands of women. The recommendations regarding PAP smears are similarly supported by rigorous science. And it's hard to label these recommendations as anti-woman, since similar recommendations, downplaying the value of screening, have been made recently regarding screening for prostate cancer.

If these recommendations are so terrible, why aren't people outraged that *no one* is recommending that women under 40 get regular mammographies? Women under 40 die of breast cancer as well. But there have never been recommendations that women under 40 routinely be screened in this manner, so continuing to not recommend such screening doesn't seem so outrageous. Yet women under 40 do get breast cancer, and they do die of it. Why doesn't this provoke the same level of outrage? Is it because we don't feel as if we're having something taken away?

Any protocol or recommendation will end up not benefitting someone. I would much prefer to receive and follow medical advice that is backed up by thirty years of statistically-sound research than by someone telling me "I knew someone who..."

As a practical matter, there are only so many doctors, so many nurses, so many radiologists, and so on. Under any health care scheme decisions must be made about what care is to be provided. The studies underlying the breast cancer screening recommendations are invaluable. More women will die of heart disease this year, and next year, and every year for the foreseeable future, than will die of breast cancer. Is continuing to devote so much time and effort to breast cancer screening, which yields little benefit, really in anyone's interest?

I'm also astonished at the number of people posting here who thing that all this testing is guaranteed; the notion that X would be alive were he tested is absurd. However good, medical science is still very, very imperfect. You can do all the testing you want and it will barely affect mortality rates.

And for those who say "well the doctor didn't test", gain some gonads and get the test fucking done yourself. Good god, since when have we become such a bunch of sheep that we only do what the doctor says? Therein lies the ultimate reason medical reform will never be effective; people simply aren't willing to accept responsibility for their own health.

Joe said, "And for those who say 'well the doctor didn't test', gain some gonads and get the test fucking done yourself. Good god, since when have we become such a bunch of sheep that we only do what the doctor says?"

Since the time that insurance companies decided to pay only if a doctor says the test is necessary.

Interesting comments. I am surprised that so many men ( I am assuming men which could be my bad) don't think ahead and realize that prostate cancer screening and surgery will also be rationed. Over 70 no surgery, you can live a few more yrs without it, and your old anyway. To the comment about what this has to do with Fed gov't. The guidelines that the Feds setup their healthcare benifits will be the same for all insurance benifits. No mandates for coverage if the Feds won' cover it.

I am surprised that so many men ( I am assuming men which could be my bad) don't think ahead and realize that prostate cancer screening and surgery will also be rationed.

Even today, prostate surgery is subject to the considered judgment of professionals. My father-in-law, who was fully covered in every way between Medicare and his supplemental policy, was told by his oncologist that he was sure to die of something else before his prostate cancer killed him, so he was better off leaving it alone. My FIL agreed, and in fact, he did die of something else.

One of the best arguments against HPV vaccine is that the vaccine doesn't remove the need for screening but it increases the chances of a false positive. This is combined with the fact that the most benefit from the vaccine goes to those who would be least compliant with annual screening, yet these are the people least likely to get the vaccine.

Further PAP smears are useful not just against cancer but for other STDs. It's also a great way to get women to get a thorough annual checkup - no birth control without a PAP - when they can easily get pregnant.

I do love that the negative, totalitarian effects of government healthcare are coming to the fore ahead of a bill being passed. If the Senate had abided by their initial timelines you would all be screwed, but now these are more nails in the coffin of a malicious and evil policy proposal. I do love how the left bloggers were bragging about the inevitability of the annihilation of medicine. It's looking more evitable by the day!

Joe said, "And for those who say 'well the doctor didn't test', gain some gonads and get the test fucking done yourself. Good god, since when have we become such a bunch of sheep that we only do what the doctor says?"

Since the time that insurance companies decided to pay only if a doctor says the test is necessary.

The answer to this is pay for it yourself.

However, this cuts out many in the lower and middle income levels who don't have the resources to self fund.

The really lower income people (Obama's chosen ones) will get government subsidies. The wealthy will just pay for the procedures. The rest of the people who work hard, pay taxes and who are in the middle will get squeezed out.

No coverage from insurance companies as dictated by government mandate, too "rich" to qualify for goverment aid and too expensive to pay for out of pocket.

Other nations handle preemies differently. They let them die, then count them as "stillborn" so as not to mess up their infant mortality statistics.

Where do you get this information? From the monkeys flying out of your ass?

My niece was 2 lbs at birth, born almost three months premature under the dreaded NHS in England. She is now a happy and healthy 16 year old.

The woman who sits across from me at work (I work at Ramstein AB in Germany) just had a baby by Cesarean under the German socialist system. No fuss and the whole procedure cost her 10 euros. And btw, German law mandates that expecting mothers get paid (100% of salary) maternity leave 6 weeks before and 8 weeks after the birth of the baby. Also, insurance (again mandated by law) covers one parent staying home with the baby for a year at 75% of salary with a guarantee that his/her job will be retained. And Germany spends about half of what the U.S. does on health care. (In the case of my coworker, her husband is staying home with the baby.)

In a parallel universe where the government has no power over decision making by medical professionals, the science and studies mentioned would be judged on their merits.

But with government in the middle of decisions, with a primary goal of reducing costs, there will be a suspicion that said government doesn't really have your interests at heart. Hell, they don't even know you exist, unless you are a member of the Washington nomenklatura.

This is why its better to have government as a referee with limited powers, rather than a player who can change and enforce the rules as well.

Sure, blame men for your anxiety - about everything - rather than learning to get a grip and focus on what's important, namely what's real. You MAY get cancer one day - or you MAY NOT - but, whatever you do, make everyone else aware of that possibility as often as possible (in the most striking terms possible) and, like Global Warming, scare the shit out of everybody you can over nothing. Then, if something does pop up, be sure to blame a man for it - or at least get angry at them - because, good god, they're there! (Any man here ever been in the delivery room when a woman has a baby? You're there for "support" - because what's happening has so little to do with you, right? It's only your spouse's and child's very lives hanging in the balance! What better time to be told you're a bastard for putting her through all that when SHE DECIDED her clock was ticking and she had to have a baby, huh? Good times,...) This modern world can be so fun!

Look, Ann, you know I'm not going along with ObamaCare, but I'm also not going along with feminism - because both are a crock - and trying to make me forget the first part of the most common phrase for women starts with "you can't live with 'em,..." ain't gonna work. They are the leaders in filling the pews, joining the cults, getting "spiritual", denouncing critical thinking, and, of course, the doctors they depend on for keeping them alive (because they're mostly men) and looking totally cockeyed at science - without understanding even the basics.

Better to follow the lead of Oprah (who you really ought to railing at - along with yourself - for helping to put these jokers in office) Madonna, Suzanne Somers - and all the other loud-mouthed believers - along with Andrew Weil, and Deepak Chopra, just to make it seem fair. Jeez.

Women's unwillingness to acknowledge their own failings - something most men have to do, regularly, in the normal course of a day - is a bigger cancer fear to me than anything going on in my own body, which I know is, someday, going to expire from *something*. Remember this conversation between a bunch of young lawyers and Thurgood Marshall:

Young lawyer: "Why are you retiring?"

Marshall: "I'm coming apart!"

I remember it as a shocking display of one man's clear-eyed acceptance of the parameters of life.

As someone said, maybe with Meade there, you'll figure it out yourself and stop this line of "reasoning". But probably not - because, as (beta male) David Walser said, you've "got skills" in this area:

Like a cat, playing with a half-dead mouse, that did absolutely nothing to you but exist.

"Other nations handle preemies differently. They let them die, then count them as "stillborn" so as not to mess up their infant mortality statistics"

It's more accurate to say IF they die, they're counted as stillborn so as not to mess up their IM (and life expectancy)statistics.

"No fuss and the whole procedure cost her 10 euros"

No Freder - if she pays taxes at all, it cost her more than 10 Euros. I understand this is a concept our friends on the left have great difficulty grasping. The fact that the government paid for something doesn't mean it's free.

"Socialized medicine sure does suck!"

Socialized medicine that free rides on medical developments paid for with profits from countries that permit for profit medicine actually doesn't suck that much, but it will in a hurry if you do away with the for profit systems.

Please dont get so upset about the new (and they're not that new) pap smear recommendations. 95% of women younger than 21 will acquire an HPV related infection. We were way over treating them in the past.

The current recommendation is for the 1st pap to occur within 3 yrs of the onset of intercourse or age 21 whichever comes first. If a pap shows a low grade lesion in a patient under 21, the recommendation is to repeat the pap in a year, not to ignore it. Since it takes on average 9 to 15 years to develop cervical cancer this is very reasonable as most of the lesions will regress on their own. IF they don't they you start the work up.

If the pap shows a high grade lesion then they get worked up no matter what.

In the past we'd wack out pieces of cervices from anybody with a low grade lesion. This increase premature labor and delivery, not a good thing. So for 20 and under, we watch low grade lesions. If they persist or get worse we work them up. High grade lesions are always worked up.

. . . so he was better off leaving it alone. My FIL agreed, and in fact, he did die of something else.

The difference is that it was your father-in-law's own decision and choice, guided by professional advice.

What we're going to see is that people will no longer be allowed to make their own decision based on their own analysis of their personal risk.

If you've never worked with or for the government, perhaps you don't understand that when the government is involved all discretion becomes lost. Bureaucrats MUST operate within the law at all times. Witness social security regulations, or that the travel pay for the Apollo was reduced because government quarters were available on the moon.

There is no end of the ridiculous results when the strict observance of the law is applied to travel vouchers. That ridiculousness becomes tragic when applied to medical care.

WHAT THE HELL DOES ANY OF THIS HAVE TO DO WITH THE FEDERAL GOVERNMENT?

Some of us recognize this as a foreshadowing of things to come. The left is preparing the ground for rationing, starting with the most plausible and least objectionable.

This highlights the greatest concern with government-run health care; when the government makes the case that your behavior is deleterious to the common good, the government has the power to ban your behavior. It will start with tobacco, then guns, then hard liquor (but not Merlot). Where is the line? Skydiving? Mountain climbing? Driving seventy on the freeway? This is not paranoia. In the end health care reform is about surrendering liberty.

The woman who sits across from me at work (I work at Ramstein AB in Germany) just had a baby by Cesarean under the German socialist system. No fuss and the whole procedure cost her 10 euros. And btw, German law mandates that expecting mothers get paid (100% of salary) maternity leave 6 weeks before and 8 weeks after the birth of the baby. Also, insurance (again mandated by law) covers one parent staying home with the baby for a year at 75% of salary with a guarantee that his/her job will be retained. And Germany spends about half of what the U.S. does on health care

Master cylinder...What is your Pope point? The equal value of women is the subject. The Catholics and the Baptists who impose an all male priesthood and preacherhood are another issue. They are wrong of course. But at the Catholic Hospitals and the Baptist Hospitals the women come in first place including in leadership.

Government health plan follows these guidelines (liberal reaction: "We must all do what we can for the common good.").

I'm not so sure. I think the liberal reaction is more likely to fight any future reductions in testing/coverage. Especially stuff that would affect them or SOMEONE THEY LOVE.Thus resulting in an unwieldy, politically-driven, massively expensive, tax-payer funded health care "reform".

Far from it. Depending upon your level of income, enrollment in the German public health plan is mandatory. Taxes to cover the public health plan is around 15% of gross income although if I remember correctly it is capped to a maximum dollar (euro) amount. Bear in mind that 15% doesn't figure in to your other taxes.

But yes, German social benefits are quite generous especiallyif you don't mind the large deductions from your paycheck. I'd argue we could also afford such generosity here in the States without a significant increase in our taxes if we closed down irrelevant bases such as Ramstein.

The pap smear recommendations are not new. Look at the details; the key would be risk assessment and then screening based on risk.

Again the basis of these recommendations regarding SCREENING RECOMMENDATIONS FOR THE GENERAL, AVERAGE RISK POPULATION are based on two basic principles: 1) does the research evidence indicate that those who get the test are less likely to die from or get sick from the disease screened for (as opposed to not getting the screen and continuing to get "routine care") 2) Is the test feasible and acceptable (and yes that will include cost considerations, along with patient acceptance, ease of providing to patients ...)

These recommendations in no way are meant to countermand any discussions/considerations/conclusions that occur between a doctor and his/her patient.

And a word about cost. Research continues to pursue an effective screen for lung cancer. In theory PET scans might do the trick (although you'll likely have a lot of false positives) But hypothetically, lets say that you can prevent 1 lung ca death for every 3,000 people screened. Average cost of a PET is about $4,000. So some entity (or the collective "we") would pay $12,000,000 for every lung cancer death saved. Is that too expensive? And if not, who should pay it? And if your answer is "its too expensive" then at what cost for life saved is a test/treatment worth paying for? AND WHO SHOULD PAY?

Righteous indignation is easy, trying to address these hard questions is the "hard work".

Shanna-you have been played by talking points that have been kicked off by Ann and her ilk.

Or I have made up my own mind because I am an adult. Did you even read what I wrote? Even the vast majority over at the NYtimes were pissed about the mammography thing. It is ridiculous to recommend that women not do self-exams and I don't think the difference in numbers is enough to make it wise to stop screening before 50.

This recommendation is not nearly so bad as the mammography ones and as the HPV vaccination really takes hold, we may be able to step back on screening to every two years or something.

Master Cylinder...My thought is that Obama is neither especially Christian nor Mohammedan; however, he feels a kinship with the Moslem views on women that his father and his stepfather demonstrated to him. He seems to me to be void of an instinctive Christian mercy and love towards people that equally includes women as people. He can prove me wrong by his actions. differently

It actually may make sense economically to cut out some of these tests, and live with the consequences.

At one point, every woman's ability to breed and have a lot of kids was fundamental to the survival of the species, or at least the community. But that time is now long gone, and the reality is that we have a significant overhang of child bearing potential in our female population. I am guessing maybe 4 or 5 to 1 right now, given the average of a birthrate around two kids per woman right now, while with modern health care, women should be able to bear 8 or 10 through their child bearing years (which are now quite a bit longer, so that might be too low).

So, it may make sense economically to cut back on all this reproductive testing, since we will still have plenty of child bearing potential, regardless. :-)

It actually may make sense economically to cut out some of these tests, and live with the consequences.

At one point, every woman's ability to breed and have a lot of kids was fundamental to the survival of the species, or at least the community. But that time is now long gone, and the reality is that we have a significant overhang of child bearing potential in our female population. I am guessing maybe 4 or 5 to 1 right now, given the average of a birthrate around two kids per woman right now, while with modern health care, women should be able to bear 8 or 10 through their child bearing years (which are now quite a bit longer, so that might be too low).

So, it may make sense economically to cut back on all this reproductive testing, since we will still have plenty of child bearing potential, regardless. :-)

Wait, it's not the Feds trying to kill our little girls! It's the radicals at the American College of Obstetricians and Gynecologists!

The previous (2004) ACOG recommendations were that screening should being at age 21 or "three years after first sexual contact". About 10% of girls in the U.S. have had sex by age 13 and 50% by high school.

There are about 10 million girls and women in the 15 - 19 year age group. There are 10 - 15 cases of cervical cancer per year in this age group, and about 1 death per year on average. Historically (1979) there were 2 deaths per year from cervical cancer in this age group.

It's not all free, but the U.S. does spend considerably more (by at least 5%) of its GDP than any other country while covering less of its population and apparently comparatively poor results.

Could you elaborate about the "comparatively poor results". What are you basing this statement on? My understanding is that survival rate is noticeably higher for most types of cancer in comparison with people under more state controlled or supplied health care systems.

Of course, if you compare the cost of testing compared to the cost of taking care of the people who get the cancer, it may be cheaper in the long run to skip the testing and let them die of cancer.

This non mandate grade C recommendation is just more proof Obama wants to kill us!

"The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decision making to the specific patient or situation.".

The common link in all of the new crisis induced goals has been the need to reduce human inhabitant's numbers by any means necessary. Our leadership seems to be tired of sharing the planet with so many people with their never ending demands. The abortion tool helps and is the first goal. The reservation of pristine lands held back from aggressive human use is the next best goal. Removing heroic medical measure that extend life spans of the masses is the third best goal. The reductin if food supply for ethanol is another good goal. The sudden increase in Pandemics from suddenly appearing new pathogens is coming on strong. Stopping usage of oil and coal to produce a goodlife and end freezing to death in Winters is also a fine thing. At this rate the last 2 billion alive can divide up what's left and declare that they "saved the earth". from a plague of people like Palin and her brats. This trend must be what makes people like Limbaugh and Beck issue such dire warnings.

So some entity (or the collective "we") would pay $12,000,000 for every lung cancer death saved. Is that too expensive? And if not, who should pay it?

This is the fundamental problem with a one-size-fits-all government run heathcare ( or any other ) system. Some people may want live as safely as possible, and maximize their years of life. Others may choose to live more dangerously, and have more enjoyable years, at the risk of having fewer of them. Some people will work extra hours for more pay so that they can afford extra healthcare for their children. In a government run system, these market signals are lost, replaced by someone else's notion of the greater good.

To answer your questions:

Is that too expensive? That is up to the individual who is considering having the test done.And if not, who should pay it?The individual who is considering having the test done.

And if you'd like some "non-governmental" bodies that have made recommendations on routine mammography for women under 50, here are a few:

ICSI from their websiteICSI is a non-profit organization that brings together diverse groups to transform the health care system so that it delivers patient-centered and value-driven care. It is comprised of 56 medical groups and sponsored by six Minnesota and Wisconsin health plans.American college of Physicians Read the nuance, please.American College of Ob-Gyn (this is a summary) they feel more strongly about this and recommend themU. of Mich (again a summary) They hedge also.Amer Academy of Family Physicians My specialties organization. They recommend it though interestingly hyperlink to the AHRQ/USPSTF web site.

I hope out of all of this patients will at least feel comfortable asking their doctor when a test is suggested "How likely am I to get the disease we're screening for?", "Will I be less likely to get sick from this disease or die from this disease if I do this test?", "What are the complications of the test?", "If the test is positive, what further tests will I need and what are their risks and complications?"

Too often a doc says "You need this test" and a patient responds with "OK"

I think that one reason that one needs to religiously follow Ann's blog comment threads is to be able to keep abreast of Titus' plans and exploits. You really need to have been reading yesterday to know what he is talking about here - his planned trip to, I believe, NH to look at an Aculapoco (Alpaca?) Farm with his (Indian) spouse to see if he wants to bail from the corporate world and get back to his farming roots.

For all those who disagree with my comment of "pay for it yourself", I have and so have people I know. You can get most tests done if you fork out the cash and not all of them are expensive (at least no more than fixing your car and many less so--just putting new tires on my Civic cost $400 and a timing belt $500.)

Yet, you missed my bigger point. Your health is YOUR responsibility, not the doctor's, not the government's--yours. If you really believe you need a test, go to the doctor and present your case, have a discussion. Is this perfect? No, but nothing in life is, so why do we expect our medical care to be so?

WHAT THE HELL DOES ANY OF THIS HAVE TO DO WITH THE FEDERAL GOVERNMENT?

Do all caps mean that you are shouting? Or that your shift lock key stuck?

I understand that you are trying to change the subject away from ObamaCare, but it does not appear to have been effective this time.

Now to the substance.

Right now, an insurance company could follow the advice of this group of doctors, and take the chance that the patient/customer would not get cancer, etc. But, most are probably not going to take the chance, since refusing to cover what should be covered, and harm being caused as a result, is the sort of thing that turns into "bad faith" and "egregious conduct". And while recommendations like this may provide some cover for the insurance companies, a sympathetic plaintiff and a good attorney may be able to make millions off of such a refusal to cover what had been covered in the past.

Now we come to the federal government and ObamaCare. Really, the only thing that ObamaCare is doing that could actually cut down on the cost of medical care is just this, providing boards and ("death") panels that would be entrusted with the power to mandate what is and is not reasonable treatment, given a patient and her circumstances. They will be not only setting a floor on medical treatments, but also, effectively, a ceiling. Private insurance companies could now use the mandates of such panels or boards to justify refusing specific treatments determined not to be cost effective by said boards or panels. And since the government has sovereign immunity, they can't be sued either, when adverse consequences arise from the refusal of the payor (private or government) to pay for some test or treatment.

Let me clarify that the reason that this cuts the cost of health care is that it is a mechanism to reduce the quantity of health care provided. Indeed, "death panels" and rationing are the only realistic ways to do this. Everything else is smoke and mirrors. But that means that those of us who have adequate health care and are happy with it, are going to have less of it, and what we get will now be controlled by the government. All in the name of leveling the playing field and spreading the wealth around.

Could you elaborate about the "comparatively poor results". What are you basing this statement on? My understanding is that survival rate is noticeably higher for most types of cancer in comparison with people under more state controlled or supplied health care systems.

You will want to to at actual mortality rates not disease-specific survival, at least for cancers that have screening programs. Screening tends to detect more cancers with inherently better prognosis.

Yet, you missed my bigger point. Your health is YOUR responsibility, not the doctor's, not the government's--yours. If you really believe you need a test, go to the doctor and present your case, have a discussion. Is this perfect? No, but nothing in life is, so why do we expect our medical care to be so?

And the response from the doctor under ObamaCare is going to be: "It really doesn't matter what I think, or, indeed, what you think. The only thing that matters here is what the federal government thinks, and they do not believe that a woman in your situation needs that test right now".

You will want to to at actual mortality rates not disease-specific survival, at least for cancers that have screening programs. Screening tends to detect more cancers with inherently better prognosis.

The point I was trying to make was that survival rates (or inversely mortality rates) look good under the current U.S. medical system for various cancers in comparison with similar metrics from other countries.

So, I was asking what metrics he was using to show that our health care was inferior.

Also, when I had read something about paps making it hard to carry a baby (leading to premies) my gyn said it's crap (after a friend had some pre-cancerous cells frozen off and a side effect is a weak cervix). She said they would just stitch it closed

McCain would have been half good and half bad. Obama has helped us over a race relations tipping point which is good. I am holding my breath until 2010 elections to see if the USA will survive Obama's destroying of America's economic and military power by a series of accidents he just keeps having. And of course the McCain by losing did his part by setting up the Gutsy Point Guard to run our offense in 2012.

The only reason why McCain would have been worse is because the MSM would hound him every single moment, along with Palin. He'd have 28% approval rating, and the GOP would be headed for total annihilation. In 2013, we'd get a President Obama with a CLEAR directive to institute wide-scale socialism. As it is now, we still have a chance to survive this menace.

I assume my wife's ok with anything that reduces the looking-closely at OWB's.

Hoosier,

Free, indeed. As a small business owner (very small--3 employees including myself) I wonder if Freder has the slightest idea how catastrophically expensive that would be? It actually would have put me out of business at just about any point in the life of the company.

Here's my experience with the German health care system. As an exchange student, I was put under the state health system. I blew out my knee. Treatment consisted of a GP who gave me an Ace bandage and a note to get out of PE for the rest of the year (can't say I was broken up), plus a scrip for PT which consisted of isometric exercises with rubber balls.

Return to the US, knee is getting worse. I go to the doc and get an MRI, have arthroscopic surgery and PT which consists not only of exercise but also ultrasound therapy and electro-therapy.

The equivalent of "take an aspirin and don't call me in the morning" versus actually treating the condition. US health care sure sucks!

I discussed this with my doc 10 years ago and she said if after LEEP the cervix was weak they just put a stitch in it.

CarmelaMotto, cervical incompetence from whatever cause is usually diagnosed after the first miscarriage. In subsequent pregnancies, depending on its severity, abdominal surgery may be required to "put a stitch in it". Also, since they have "put a stitch in it", Caesarian (surgical) birth is sometimes required. Bed rest for the last half of pregnancy is often prescribed in addition to cerclage ("putting a stitch in it".)

Your doctor sounds awfully cavalier about the consequences of cervical damage, if a woman has any desire at all for children.

About 25 years ago, I worked with some young lawyers who were women, females, I don't know how else to characterize them in PC-ese.

They had started in poverty law programs after lawschool until they found that that meant poverty wages. So they went to work for capitalism & keeping corporate America safe.

But they hastened to assure me that they still volunteered for pro bono work. I remember one of them telling me that she educated poor, uneducated Black Women (an unintentional but deserved slur on the NYC Public School System, but I digress) on the need for mammograms under Medicaid & how breast cancer was more fatal to Black Women because too many didn't find out 'til it was too late. She had stats galore & I was very impressed with her studiousness & her dedication. (I no longer laughed at the expensive capitalist clothing she wore.)

Yesterday & today I watched, on FOX, a doctor, a woman, female, who, if I understood her (she was rather shrill, OK, make that stentorian), was saying that the new version of The Breast Checking Bible & Pap Tests/Pelvic Exam Bible were each the one true book on those subjects & all others were heretical, so that it wasn't necessary any longer to get tested early on or tested very often later on for that matter & that my understanding that mammograms & Pap Tests/Pelvic Exams saved most women who got such cancers from dying from such cancers was, well, inoperative. And furthermore, that it's not worth the cost since so few are saved & many now can be saved from the discomfort or something of getting mammograms & Pap Tests/Pelvic Exams.

We were always at war with unnecessary medical testing.

I guess it will be the same for prostate cancer with men, tho I can attest that the “discomfort” lasts for only a nanosecond, even if one is not meditating on other things like women's breasts & that only a wuss would complain about or fear the test. (No responses about false positives from prostate tests or the reasonable cost/benefit decision made by males over 80 who test positive that they will not live long enough to die from that cancer, please.)

A young minor celebrity in Britain died not too long ago of cervical cancer. Which is normally detected pretty early, but not by Britain's vaunted NHS, apparently.

Or Katie Brickell. Britain's NHS raised the age of pap smears from 20 to 25, leaving Katie to face a diagnoses of cervical cancer at age 23.

After going to private insurance, and having a hysterectomy, she says:

"It is the Government which sets out the guidelines, not the nurses and the doctors on the front line," she said.

Mrs Brickell was given a dual course of drugs – two courses of drugs at a time – which she believes she would not have got on the NHS. "Trouble is, double the drugs is double the price," she said. "On the other hand, if it had been on the NHS I would have had to get a lot of clearance to get that level of care. On private, that just was not an issue. If I needed a scan, it was immediate. On the NHS, it was often a two or three-week wait."

I had an irregular pap smear and am supposed to go every 6 months. I'm 26, almost 27.

Will Obamacare cover this before or after it throws me in jail? Or am I just to curl up and die because a pap is just too darned expensive to keep me alive?

Nothing could be worse than Obama; we'll all learn that if health care passes and private insurance companies dump employees when they close their doors. 10.2% unemployment will seem like a dream when we're looking at 25-30% unemployment thanks to Hope, Change, and Death Panels.

Sanjay Gupta ripped into the new guidelines if this transcript is correct. I find myself wishing he'd taken the SG position.

I had a false positive two years back on my yearly mammogram. I'd actually skipped the previous year, so that did indeed raise my anxieties. Every time I'd had the exam before I'd cheerfully placed by tender parts in the vice, turned and twisted as told, then gone home and waited for a call from the doc. It was always a big nothing. Blase. But immediate after that the exam in 2007, the technician came back in the room and said hey, we have to do this again, on a different machine. And from there it was tense. A week later, all was well. Post-Katrina, my films didn't make it from the previous testing site to the current one, so they'd had no recent baseline to compare the image with, and were concerned about a little shadow that's always been there.

I will take that few days of anxiety, thanks. It was a small burden to bear.

You can say man up and pay for your own vagina, but I was talking with my oncologist yesterday, and she is extremely worried about a massive wave of retirement of physicians and a drop-off of people seeking to go to medical school. There is going to be a shortage of doctors. You can't get optional tests when the gummint desk jockey says no and black market elective tests will quickly be illegal and won't even be available because of the doctor shortage.

Doctor earnings are going to be cut 20% by 2012, while simultaneously they are required to purchase EMR systems out of their own pockets at $125-250k.

And about the swine flu: I asked her about the vaccine because I heard mixed things...and she is also an infectious disease specialist and told me about the cases she had been working with. Not by name of course. I'm like, after all that damned surgery, chemo, radiation, herceptin, tamoxifen, and femara, I am NOT going to be felled by a stupid flu. Gimme that shot. :-)

kl, I got the shot. I had no worries about side effects. I'm much more sure that having the flu would be a serious trial for me, having asthma. I've had a bunch of students out with it over this semester.

kl - how many doctors are going to be buying individual EMRs? Those things are institutional; doctors in small practices set themselves up in business with larger providers and are part of their EMR system.

When I had surgery this summer, I felt pretty good about the care I got, in part because my record was available onscreen at every stop along the way. My ob/gyn and primary care doctor are in the same hospital system here, which they joined after the storm. Both said that one of the best things about moving from their previous institution to Ochsner is Ochsner's EMR. I assume the EMR is paid for in part through fees they pay to be part of Ochsner's system, but that cost is disbursed through thousands of doctors, all over the region. I'll ask next time I have reason to see one of them (no time soon.)

However, this cuts out many in the lower and middle income levels who don't have the resources to self fund."

You got that right. In spades. My question is "Why?"

On another blog not too long ago (or maybe it was even this one), someone posted a scan of an old price list from the 50s from the maternity ward of a hospital (I think) stating the regular cost of a baby delivery as about $30 or $35. The blogger estimated that to be something like $150 today, which sounds about right to me.

Try to find a doctor that will do a delivery for that today. Again, why? Why has the real inflation of medical services been so spectacularly high? My own instinct tells me lawyers, litigiousness and the legal lottery but I can't say that's based on anything but headlines of multimillion dollar settlements won against doctors and my brother-in-law who runs a few prosthetic clinics telling me about malpractice insurance.

Why is nobody talking about tort reform? What is the real impact of legal costs and defensive medicine on medical costs? I follow these things pretty closely and I still have no idea.

Freder Frederson said, "The woman who sits across from me at work (I work at Ramstein AB in Germany) just had a baby by Cesarean under the German socialist system. No fuss and the whole procedure cost her 10 euros. And btw, German law mandates that expecting mothers get paid (100% of salary) maternity leave 6 weeks before and 8 weeks after the birth of the baby. Also, insurance (again mandated by law) covers one parent staying home with the baby for a year at 75% of salary with a guarantee that his/her job will be retained. And Germany spends about half of what the U.S. does on health care."

Free? No, it was just paid for by all Germans, by their taxes and also in other ways. We have a German friend who was let go from her job because she 'might have another baby.' That's right. Because she might get pregnant again, she might go on maternity leave, she might have to care for a sick child (though her husband stayed home with the 2 children), she might have to act as a mother. It had nothing to do with her job performance it was completely based on what might happen.

To those who point out that we in the US spend more on medical care than other developed countries, I would like to say this. We also spend more on education, charity, pet food, entertainment, and probably lots of other things I don’t know about. In a more or less free market, if you don’t think it’s worth the money, don’t buy it. That’s the choice you have. I don’t think taking away our choices is a good way to go.

It will start with tobacco, then guns, then hard liquor (but not Merlot).

Did you know that there is a Congressional Wine Caucus? Yep, wine is made in all 57 states and employs more than a million directly. Schwarzenegger wanted to raise tax on wine but was discouraged by the wine Caucus and industry leadership (one suspects Napa Valley Vintner Pelosi weighed in heavily against). American wine will be the last untaxed "luxury" standing.

Suppose the funds saved by adopting the USPTF guidelines produced a result, through funding research, that eating radishes three times a week prevented all cases of breast cancer. Wouldn't we be ahead of just continuing to throw ineffective testing at a difficult disease. Let's not settle for the illusion of control...let's get control through doing the right thing.

Women and babies consume a hugely disproportionate amount of health care - but that is just inevitable given the systems and complexities involved, but assuming that we want to continue the species, that's just the deal.

The species seemed to get along just fine without any healthcare, as do other species. Nature is pretty good about that. In fact human reproductive rates were a lot higher in the pre--expensive-healthcare days.

I realize you're being sarcastic, but I actually agree with some of your snarkish exaggerations: Health care dollars are a zero sum game, so if you're saving that one-in-a-million 15 year old, you are probably killing 1000 15-year-olds in a more deserving and cost-effective area. We can't save everyone. It's sad, but it's true. The one in a million who dies might have died anyway, even if we had spent that unreasonable sum trying to save her. It's like the money spent on AIDS research and treatment which is wildly out of proportion re: the actual number of cases and fatalities compared to other diseases, and taking into account AIDS is mostly spread by intentional dangerous behaviour, it's a disgrace and a scandal that the huge amount of the resource pie goes toward it. It IS a fact women have a longer life-span than men, it IS a fact they hog more health-care dollars. It's not at all unreasonable to ask them to take more cuts, especially if completely ridiculous statistics like your one-in-a-million 15-year-old are really true, the responsible thing to do is to eliminate all the programs which don't really give enough bang for the buck.

You can take this 'government responsibility' thing to the nth degree, giving everyone a nice house, nice clothes, a balanced diet, a car, a job, an education and everything that would theoretically give them a perfect and "fair" life. But reality intrudes: it costs so much, you'd be robbing the actual working class of their right to happiness. Sorry if people die, but I personally don't think the government should have a role in subsidizing health care at all, not a penny. Taxes should be cut to offset that, and if you want to buy healthcare or health services, you are free to do that. Don't ask me to pay for it, though. Nor the arts. Nor PBS. And on and on.

...I was talking with my oncologist yesterday, and she is extremely worried about a massive wave of retirement of physicians and a drop-off of people seeking to go to medical school. There is going to be a shortage of doctors.

It's already here, particularly among the primary care sector that "health care reform" of any kind must depend on. And it's going to get worse.

I have zero problem with changing medical guidelines. Guidelines are always changing. At my lab, we are constantly fiddling with the way we do things, constantly deciding whether tests are helpful, would more be better, are there contraindications, and so forth. In the course of time, let the doctors work it out.

The problem here is only and entirely, Now that the government is involved, is this guideline based on politics? Is it based on someone somewhere who thinks that Obamacare needs to cut costs, so let's lean in that direction? In other words, Death Panels.

Of course, if you love the government, you can trust they wouldn't do that, so that's okay.

The main issue is leftwing womens groups trying to replace the role normally filled by a partner; such as access to health insurance through marriage or help paying bills with combined incomes, to the Government, which means the rest of us.

It is to perpetuate Patriarchal societal obligations in favor of women over men by force of law, while claiming the freedom of "liberation" to do whatever they please, with no input by men allowed, other than "yes, dear".

Its really quite sexist.

It's really a War against Requiring Women to be Personally Responsible for their Routine, Non-emergency Medical Costs. And its being waged by the Feminist left on the rest of America.

If Feminists realized just how tone deaf they are on the issue, they'd be shutting up about it.

Women and babies consume a hugely disproportionate amount of health care - but that is just inevitable given the systems and complexities involved, but assuming that we want to continue the species, that's just the deal.

Seems to me that the species managed just fine for hundreds of thousands of years with zero expenditure on women and babies. Those countries with the highest fertility rates today are those with the lowest expenditure on women and babies.

Let's not kid ourselves that we spend a lot of money on women and babies because it is necessary to continue the species. Nature is a lot smarter than that.

"Health care dollars are a zero sum game, so if you're saving that one-in-a-million 15 year old, you are probably killing 1000 15-year-olds in a more deserving and cost-effective area. We can't save everyone. It's sad, but it's true."

No, absolutely wrong. There's no natural scarcity of health care. There's no fixed upper limit on the number of doctors, nurses, lab tests, procedures, or anything else associated with medical care. It's pretty much the opposite of a zero-sum game.

This was always a much bigger issue than mere long-term budget deficits or even the mandate--that the government, with strong budget incentives to not approve expensive tests and treatments, will decide what tests and treatments to cover, and you have no realistic right of appeal. But even so, the cost of this mess will be so huge they will have to tax your wallet clean, so you won't afford to pay for it yourself.

Your breast exam or C-section or arthritis or bad heart is competing in the budget with education, national defense, and everything else. And politicians will set the priorities, working through IPAB as a smokescreen. But, you better believe the politically potent diseases will eb covered, and orphan diseases won't. Don't you or your loved one get anything rare and expensive. But, no Senator's kid will ever do without. Feel good?

Well, that and the fact that with government price controls and taxes like the device tax, innovation will dry up because new inventions and drugs and procedures won't have a good chance of paying off, so the risk capital will go elsewhere. Then the govt will increase your taxes even more, to fund the R&D the private sector no longer does, and it'll be medical Solyndras as far as the eye can see.

In the larger scheme of things, the individual mandate and even the deficits are small beer among the problems with Obamacare.

"...I was talking with my oncologist yesterday, and she is extremely worried about a massive wave of retirement of physicians and a drop-off of people seeking to go to medical school. There is going to be a shortage of doctors."

My wife's pain specialist and orthopedic surgeon tell her the same thing. Her rheumatologist just rolls her eyes. My GP, ditto. Not a single doc has said flat out this won't happen, they either say it will or are non-committal.

As I said in yesterday's bloggingheads, I still think McCain would have been worse.

No, you're just being a typical hard-headed human being, who can't admit when he/she's wrong.

As bad as McCain would have been, nowhere in any reality whatsoever could McCain have been worse. And when you've been called on that very point, you've never attempted to explain why you still think that way.